Apex Sports Clinic

Femoroacetabular Impingement (FAI)

Let’s understand Femoroacetabular Impingement (FAI)

What’s the Condition?

Femoroacetabular Impingement (FAI) is a condition where abnormal bone growths in the hip joint cause the bones to rub against each other, leading to damage in the hip joint’s cartilage and labrum. This abnormal contact occurs between the femoral head (the ball of the hip joint) and the acetabulum (the socket). FAI can significantly impact athletes, causing pain and reducing performance due to decreased hip mobility and joint damage.
FAI is of 2 main types,

  • Cam Impingement – This occurs when the femoral head (top part of the thigh bone) has an irregular or unusual shape and fails to fit into the hip socket.
  • Pincer Impingement – This occurs when the hip socket is formed differently and covers a larger part of the femoral head.
  • Mixed Impingement – This occurs when both Cam and Pincer types are involved.

Femoroacetabular Impingement (FAI)

A labral tear is an injury to the labrum, a crucial ring of fibrocartilage that surrounds the hip joint's socket, known as the acetabulum

Let's’ explore the causes:

Sports that involve intense, repetitive hip movements can significantly exacerbate Femoroacetabular Impingement (FAI). Activities like soccer, hockey, football, and martial arts place continuous and high demands on the hip joint. The frequent pivoting, twisting, and rapid directional changes required in these sports put excessive strain on the hip, increasing the likelihood of impingement. Sports that necessitate repetitive hip flexion and rotation, such as cycling, running, and dancing, subject the hip joint to constant stress. This repetitive action can wear down the joint over time, leading to or worsening FAI. For example, long-distance runners consistently flex their hips with each stride, while dancers perform complex movements that require significant hip rotation.and high-impact sports often involve direct blows or falls that can immediately affect the hip joint. Contact sports like football and hockey have a higher risk of acute injuries, where collisions or falls can cause sudden bone and joint damage. Such trauma can accelerate the development of FAI by causing the bones to grow abnormally or by directly damaging the joint structures, including the labrum and cartilage.

Despite its name, tennis elbow is not limited to tennis players, but the sport’s repetitive racquet swings, particularly single-handed backhands, can significantly contribute to this condition. The repeated swinging motion during a golf swing, especially when gripping the club tightly, can strain the tendons in the elbow, leading to microtears and inflammation. Pitchers and other players who frequently throw the ball are prone to developing tennis elbow due to the repetitive overhead motions involved in pitching, throwing, and catching. Certain weightlifting exercises, such as curls, bench presses, and overhead presses, can also stress the tendons in the elbow, especially when performed with poor technique or excessive weight. Drawing and releasing a bowstring repeatedly can strain the forearm muscles and tendons, particularly in the elbow, contributing to the development of tennis elbow.

What are the Symptoms?

Hip Pain:

Athletes with FAI often experience sharp, stabbing pain in the groyne area. This pain is typically most noticeable during or after physical activities that involve hip flexion and rotation, such as running, jumping, or kicking. The pain may also radiate to the thigh or buttocks, making it uncomfortable to perform everyday activities. The intensity of the pain can vary with activity levels. High-intensity movements exacerbate the discomfort, while prolonged periods of inactivity can also lead to stiffness and dull aching.

Stiffness and Limited Range of Motion:

FAI can cause significant stiffness in the hip joint, making it challenging to move the hip freely. This stiffness is often most apparent in the morning or after long periods of rest.

Reduced Mobility:

Athletes may struggle with movements that require a wide range of motion, such as deep squats, lunges, or high kicks. This limited mobility can impede performance and make it difficult to engage fully in sports activities.

Catching or Clicking Sensation:

Many athletes report a catching or clicking sensation in the hip joint. This is often due to labral damage caused by the impingement. As the femoral head and acetabulum rub against each other, they can cause the labrum to catch or tear, leading to these sensations.

Decreased Performance:

Due to the pain and reduced mobility associated with FAI, athletes may notice a significant decline in their performance. They might find it challenging to maintain the same intensity and duration of training or competition.

Treatments Choices

Non-Surgical Treatments:

Rest and Activity Modification:

Reducing or avoiding activities that exacerbate symptoms can help manage pain and prevent further damage. Athletes may need to temporarily or permanently modify their training routines.

Physical Therapy:

Tailored exercises aimed at improving hip strength, flexibility, and range of motion can alleviate symptoms. Physical therapy focuses on correcting movement patterns to reduce joint stress.

Surgical Treatments:

Arthroscopic Surgery:

Minimally Invasive Procedure:

Arthroscopic surgery involves making small incisions in the hip area and inserting a camera (arthroscope) and specialised instruments. This allows the surgeon to visualise the inside of the hip joint and perform necessary repairs. The surgeon uses tools to shave off excess bone growths (cam or pincer lesions) that contribute to impingement, restoring the normal shape of the hip joint. If the labrum is torn or damaged, it can be repaired using sutures or anchors to reattach it to the acetabulum, restoring stability and function to the joint.
Any damaged cartilage within the hip joint can be addressed during arthroscopic surgery. Techniques such as microfracture or cartilage debridement may be used to promote healing and reduce pain.

Open Surgery:

Extensive Corrections

In cases where the impingement is severe or complex, open surgery may be required to fully address the issue. This approach allows for more extensive access to the hip joint, enabling the surgeon to perform larger corrections. For extensive labral tears or cases where arthroscopic repair is not feasible, open surgery provides the opportunity for a more thorough repair of the labrum. Open surgery may involve procedures to realign the bones of the hip joint, such as osteotomies, to correct underlying structural abnormalities contributing to impingement.

Post-Surgical Management

Following surgery, a period of rest is crucial to allow the hip joint to heal properly. Patients may need to use crutches or a walker to avoid putting weight on the operated hip. Rehabilitation begins with gentle movements and exercises to prevent stiffness and promote healing. Over time, activity levels are gradually increased as tolerated, with a focus on restoring range of motion and strength. A structured physical therapy program is essential for optimal recovery. Therapists guide patients through exercises aimed at improving hip mobility, strength, and stability. Therapy sessions may include manual therapy, stretching, strengthening exercises, and functional activities tailored to the athlete’s specific sport. Athletes must follow a gradual return to sport protocol under the guidance of their healthcare team. This protocol typically involves progressive increases in sport-specific activities and intensity levels to ensure a safe and successful return to play.

Understanding and managing Femoroacetabular Impingement is crucial for athletes to maintain their performance and prevent long-term hip damage. Early diagnosis, appropriate treatment, and comprehensive rehabilitation are key to successful recovery and return to their favourite sport.

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Dr.Foo Gen Lin_Apex Sports Clinic